Abstract:

Consensus and controversy on endoscopic resection of duodenal papilla tumor        ZHOU Ping-hong, XU Jia-xin. Endoscopy Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: ZHOU Ping-hong, E-mail: zhou.pinghong@zs-hospital.sh.cn
Abstract    As the development of the endoscopic examination technique, the detection rate of early duodenal ampullary tumors has increased. An active surveillance is not suitable for the actual medical condition of China. Besides, because of the high incidence of adverse events and mortality, surgery for the benign tumors is not suitable. Fortunately, endoscopic papillectomy has been widely accepted for its minimal invasive and safety. All the measures should be performed to assess the neoplasms and decide the optimum therapy. Biopsy specimens are obtained and evaluated from ampullary lesions suspicious for neoplasia. Endoscopic ultrasonography (EUS) evaluation is to estimate the invasion of the neoplasm and features concerning for malignancy. And endoscopic retrograde cholangiography (ERCP) with both biliary and pancreatic duct evaluation is to assess for evidence of extension into either ductal system. Although the standard procedure for endoscopic resection remains controversial, prophylactic pancreatic duct stent placement and rectal indomethacin during papillectomy are recommended to reduce the risk of postprocedural pancreatitis. Patients undergoing endoscopic resection of ampullary neoplasms should be included in an endoscopic surveillance program to ensure complete tissue removal and assess for disease recurrence. It is recommended that individualized therapy should be selected by the comprehensive evaluation of the clinical history, combination with the skills of the endoscopist, and the balance of the adverse events and the risk of disease.

Key words: duodenal papilla tumor, endoscope

摘要：

随着内镜检查技术的发展，十二指肠乳头肿瘤早期的检出率有所提高。良性肿瘤密切随访监测不适合我国国情，外科手术又因严重并发症发生率和病死率较高而得不偿失。内镜十二指肠乳头肿瘤切除术因其微创、安全逐渐被接受，但治疗策略仍存在争议。术前评估时须对肿瘤进行精确活检，以获得初步病理学诊断；对于高度疑癌病灶，行超声内镜进行浸润深度评估，内镜逆行胰胆管造影（ERCP）进行胰胆管浸润程度的评估，指导治疗方案选择。内镜十二指肠乳头肿瘤切除术标准流程尚存争议，但推荐预防性放置胰管支架及吲哚美辛栓纳肛，以减少术后胰腺炎的发生风险。治疗后病人均需定期进行内镜随访，观察有无肿瘤残留及复发。建议结合临床资料、术者能力，平衡并发症和疾病风险，选择个体化治疗方式。

关键词: 十二指肠乳头肿瘤, 内镜